摘要
背景胃食管反流病(GERD)发病率呈逐年上升的趋势,而提供科学的健康教育、加强症状管理是控制GERD患者反流症状、降低并发症发生率及提高其生活质量的关键,因此有必要检索相关高质量的证据进行总结与评价,以促进GERD症状管理的临床实践。目的基于循证方法和要求,对GERD症状管理相关指南/共识进行质量评价和内容分析,以期为促进证据的临床转化提供理论依据。方法以"gastroesophageal reflux、GERD、nonerosive reflux disease、reflux esophagitis"为英文检索词,计算机检索国际指南协作网(GIN)、美国国立指南库(NGC)、新西兰指南工作组(NZGG)、英国国家卫生与临床优化研究所(NICE)、安大略注册护士协会(RNAO)、澳大利亚临床实践指南数据库(ACPG)、世界卫生组织(WHO)。此外,采用主题词与自由词相结合的方式,以"gastroesophageal reflux/GERD/nonerosive reflux disease/reflux esophagitis""Guideline/Guidelines as Topic/guideline*/consensus*/routine*/recommendation"为英文检索词,检索PubMed、Cochrane Library数据库;以"胃食管反流病/非糜烂性反流病/反流性食管炎/GERD""指南、规范、指引、共识、建议、指导、规范"为中文检索词,检索中国知网、万方数据知识服务平台和维普网,并辅助追溯参考文献。检索时间均为2014-01-01至2019-12-31。应用AGREEⅡ和共识质量评价工具对最终得到的指南/共识进行质量评价,汇总GERD症状管理的推荐意见。结果初检共获得相关文献1593篇,经过逐层筛选,最终纳入2篇指南(均来自国外)、6篇专家共识(均来自中国)。AGREEⅡ评价2篇指南的平均得分:范围和目的80.56%、参与人员73.61%、严谨性75.00%、清晰性80.56%、应用性50.00%和独立性87.50%,推荐级别分别为A级和B级;2篇指南的组内相关系数(ICC)均>0.75,一致性较高。2名研究者对6部专家共识各条目的评价结果一致,均为"纳入"。最终形成的GERD症状管理有关的推荐意见包括疾病辨别筛查、疾病确诊、并发症的诊断、饮食宜忌、起居调摄、心理指导、用药指导、治疗指导8个方面。结论纳入的关于GERD的2篇指南(均来自国外)、6篇专家共识(均来自中国)总体质量较高,但还需进一步规范指南/共识的制定和报告流程。经质量评价和内容分析后最终得到的GERD症状管理的推荐意见包括:疾病辨别筛查、疾病确诊、并发症的诊断、饮食宜忌、起居调摄、心理指导、用药指导、治疗指导8个方面,可为医务工作者进行GERD症状管理提供循证依据。
Background The incidence of gastroesophageal reflux disease(GERD)is increasing year by year.Interventions such as scientific health education and strengthening symptom management are the key to controlling reflux symptoms,reducing complications and improving quality of life in these patients.So it is necessary to screen,summarize and evaluate relevant high-quality evidence to promote the clinical management of GERD symptoms.Objective To evaluate the quality of the guidelines/consensuses on the management of GERD symptoms using related evidence-based instruments,to provide a theoretical basis for promoting the translation of evidence into practice.Methods For retrieving guidelines/consensuses on the management of GERD symptoms published from January 1,2014 to December 31,2019,we searched websites of Guidelines International Network,National Guideline Clearinghouse,New Zealand Guidelines Group,National Institute for Health and Care Excellence(NICE),Registered Nurses'Association of Ontario,Australian Clinical Practice Guideline,and World Health Organization using“gastroesophageal reflux”“GERD”“nonerosive reflux disease”and“reflux esophagitis”in English as search terms,and databases of PubMed and Cochrane Library using medical subject headings and free terms in English including“gastroesophageal reflux/GERD/nonerosive reflux disease/reflux esophagitis”“Guideline/Guidelines as Topic/guideline^*/consensus^*/routine^*/recommendation”,and databases of CNKI,Wanfang Data and VIP using“胃食管反流病/非糜烂性反流病/反流性食管炎/GERD”“指南、规范、指引、共识、建议、指导、规范”in Chinese as search terms.In addition,references of relevant guidelines/consensuses were also retrieved.AGREEⅡand related quality assessment tools were used to evaluate the quality of the guidelines and consensuses.The recommendations on the management of GERD symptoms were synthesized.Results A total of 1593 articles were obtained,and 2 guidelines(published abroad)as well as 6 consensuses(published in China)of them were finally included after gradual exclusion.The average domain scores for the guidelines evaluated by the AGREEⅡwere 80.56%for scope and purpose,73.61%for stakeholder involvement,75.00%for rigour of development,80.56%for clarity of presentation,50.00%for applicability,and 87.50%for editorial independence,with 1 was rated as grade A and another as grade B,respectively.The intra-class correlation coefficient of the 2 guidelines was 0.75,and the inter-rater agreement was high.The items of the 6 consensuses were rated as“included”.The summarized recommendations include eight parts:GERD screening and discrimination,diagnosis of GERD,diagnosis of complications of GERD,appropriate diet,lifestyle interventions,psychological guidance,medication guidance,and treatment guidance.Conclusion The overall qualities of the included guidelines and consensuses are high,but the process of developing and reporting still needs to be further standardized.The recommendations(consisting of GERD screening and discrimination,diagnosis of GERD,diagnosis of complications of GERD,appropriate diet,lifestyle interventions,psychological guidance,medication guidance,and treatment guidance)summarized after quality appraisal,may be used as evidence for both medical workers and patients in the management of GERD symptoms.
作者
李紫梦
康艳楠
罗如珍
张春梅
靳英辉
刘彦慧
LI Zimeng;KANG Yannan;LUO Ruzhen;ZHANG Chunmei;JIN Yinghui;LIU Yanhui(School of Nursing,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Center for Evidence-based and Translational Medicine,Zhongnan Hospital of Wuhan University/Center for Evidence-based and Translational Medicine,Wuhan University/Department of Evidence-based Medicine and Clinical Epidemiology,Second Clinical College of Wuhan University,Wuhan 430071,China)
出处
《中国全科医学》
CAS
北大核心
2020年第33期4151-4159,共9页
Chinese General Practice
基金
国家自然科学基金资助项目(71974143)。
关键词
胃食管反流
体征和症状
指南
循证医学
质量评价
Gastroesophageal reflux
Signs and symptoms
Guidebooks
Evidence-based medicine
Quality assessment
